单孔腹腔镜行后腹腔肾上腺肿瘤切除术的临床研究

The clinical study of retroperitoneal laparoendoscopic single-site surgery(LESS) and conventional laparoscopic adrenalectomy

目的探讨单孔后腹腔镜肾上腺肿瘤切除术的安全性及临床疗效,评价单孔后腹腔镜肾上腺肿瘤切除术的临床应用价值。方法收集经后腹腔途径行腹腔镜肾上腺肿瘤切除术病例142例,其中单孔腹腔镜组68例(A组),传统多孔腹腔镜组74例(B组),收集两组患者的临床资料﹑术中及术后数据进行统计学分析。结果两组手术均获成功,无中转开放手术,单孔后腹腔镜组无中转传统多孔腹腔镜。单孔腹腔镜组在手术切口长度、术后肛门排气时间、VRS疼痛程度分级、术后使用止痛药例数和术后下床活动时间方面优于传统多孔腹腔镜;两组患者在手术时间、术中估计出血量、术中术后并发症、术后伤口引流量、伤口引流管拔除时间和术后住院时间差异无显著性。结论单孔后腹腔镜肾上腺肿瘤切除术安全可行,其美容效果肯定、术后疼痛更轻且恢复更快。在熟练的传统腹腔镜操作基础上开展单孔腹腔镜手术有助于减少手术时间,缩短学习曲线。

【Objective】To evaluate the clinical efficacy and value of laparoendoscopic single-site surgery（LESS） in retrospective or conventional laparoscopic retroperitoneal adrenalectomy. 【Methods】68 patients underwent LESS retroperitoneal adrenalectomy（Group A）, another 74 patients with benign adrenal tumors served as a conventional multiport laparoscopic retroperitoneal adrenalectomy（Group B）. The clinical intraoperative, postoperative data were compared retrospectively between the two groups. 【Results】There were significant differences between the two groups in terms of length of incision, time to anal exsufflation, cases of postoperation analgesia, postoperative pain verbal rating scale（VRS）, time to ambulation（P〈0.05）; no significant differences between the two groups in terms of the operative time, intraoperative estimated blood loss, perioperative complications, drainage volume, time of postoperative drainagea, postoperative hospital stay（P〉0.05）.【Conclusion】Retroperitoneal laparoendoscopic single-site surgery（LESS） adrenalectomy is a safe and effective procedure, which presents a better cosmetic outcome,less postoperative pain and quicker postoperative recovery based on the extensive experience with conventional laparocopic skill,which helps to reduce the operation time, shorten the learning curve.